Eating Before Performing – One Page Fact Sheet

The day of a performance, I often feel nervous and sometimes skip lunch, only to feel hungry later. Performances are usually in the evening so I know I need to eat something beforehand. Playing extended sets, I rarely get a break. What foods can I eat and at what times to supply me with enough energy to perform well the entire time?


Download the Eating Before Exercise (PDF)



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Athletes and the Arts: An Amazing Representation

Amazing imagery demonstrating athletes and the arts!

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The Affordable Care Act: What it means for artists of all disciplines


The national health care reform law known as the Affordable Care Act, has several nicknames such as the ACA and ObamaCare. The law used Massachusetts’ landmark 2006 health care reform law as one of its key templates*. This is a three part blog post focusing on the ACA. The first two parts share important information and web links about the ACA as it pertains to individuals and families. The focus of the third part is to highlight how important it is for artists of all disciplines to become involved in health care reform policy. Artists of all disciplines are a population that has one of the highest rates of uninisurance in our country and it is usually double the rate of the general public. Our population needs to be highly visible on all levels of the health care policy  arena (local, state, federal) to best ensure that reform is successful for our community.

One key tip we can not stress enough for artists of all disciplines: Find a local community health center and/or a health care advocacy organization in your region that can act as a resource and hopefully as an advocate for you. This is especially important if you are self employed, have some self employment income, are a seasonal employee, have multiple employers, have fluctuating, and/or hard to determine income. Do not go it alone when enrolling or navigating the new ACA programs. Trust us on this. Two on-line resources to help you find a community health center:

*’s home state is Massachusetts.


Part One- Some of the Key Basics on the ACA 

1) Pre-Existing Conditions and Dropped Coverage

The artist community has sadly experienced the horrible results of wide scale discrimination from health insurance companies. In the 80’s and early 90’s, during the first wave of the HIV/AIDS crisis in our country, those living with the disease often lost their coverage either from losing their jobs that provided their insurance* or losing their jobs from being too sick to work. The insurance companies also dropped coverage when it  learned of someone’s “condition” or if  they  decided the person belonged to what was deemed a high risk group more susceptible to contracting the disease. If the person was able to obtain health coverage from another job or tried to obtain it on their own, they were usually denied coverage due to their “pre-existing condition” and/or if they were thought to belong to a “high risk group” .

Massachusetts in the early 1990’s banned insurance companies from using pre-existing conditions as a means to deny coverage. It also banned them from dropping coverage when ever they felt like it. The ACA has followed suit. By 2014, everyone in this country will have these same needed protections.

* At that time people living with HIV/AIDS had no legal protection from discrimination.

2) No life time caps, annual limits on coverage, waivers or riders.

The ACA will also bar insurance companies from placing life time caps or annual limits on coverage. In other words, they won’t be able to deny financial coverage to any one who needs expensive health care such as cancer treatment, heart transplants and other types of care that have a high price tag.

Please be aware that the only exceptions from this rule are the health insurance plans offered to students by colleges/universities or if the employer’s plan is self-insured. In those cases, check with your insurance company, not the employer/college/university for clarification.

* Many large companies, unions, or other large organizations often self insure their health plans- ask your HR department if your employer sponsored health plan is self insured.

3) Children can stay on their parent’s health insurance plan up to the age of 26.

Parents should check to see if their employer sponsored health plan offers this as an option. Again it is best to check with the insurer. Self-insured health plans are exempt from this requirement. Some self-insured plans, however, may decide to offer this benefit to remain competitive in the “job market”.

4) Insurance companies won’t be able to charge women more than men for their health plans. 

No more discrimination based on gender. Enough said.

5) The ACA now requires insurers to be transparent with how they spend the money they collect from premiums. 

Starting in 2011 insurers are now required by the ACA “to spend between 80 and 85 percent of every premium dollar they collect on medical care (as opposed to administration, advertising, etc.). If insurers exceed this threshold, they have to rebate the excess to their customers.” This is called the Minimum Medical Loss Ratio for Insurers.

Above quote from:

 6) Many individual and families will qualify for health care tax subsidies. 

Many individual and families who are earning 400 percent or less of the Federal Poverty Line (FPL) will more than likely qualify for tax subsidies to help them pay for their health insurance. The tax subsidies are on a sliding scale and are based on income levels. Basically premiums are capped for those 400 or less of the FPL. Worth noting from the Kaiser Family Foundation online calculator: “All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid. Others with higher incomes may also be eligible, depending on rules that vary by state.” 

These subsidies are only for those who are purchasing coverage on their own through the Exchange and there are certain exceptions (The Exchange and the exceptions will be discussed in Part Two). For example, those who have income between 300 to 400 percent of FPL, who have or are offered employer sponsored insurance health insurance that requires a premium payment that is 9.5 percent or less of their annual gross pay/income, will not be eligible for the subsidy. From the Kaiser Family Foundation online calculator: “In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.5% of income for the employer-provided coverage.”

The Kaiser Family Foundation has created an online calculator to show the subsidies and the caps for different families and individuals at different income levels:

 7) Some links worth reading:

 11 Facts about the Affordable Care Act

FACT SHEET: The Affordable Care Act: Secure Health Coverage for the Middle Class

Kaiser Family Foundation Summary of the New Health Reform Law

Kaiser Family Foundation Health Care Reform Source website:


Next Up- Part Two- The Exchanges, The Individual Mandate, and Income Eligibility

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What can the performing arts learn from sports?

In recent years, a number of novel initiatives have emerged that stand to impact upon the way performing artists are trained and carry out their professional activities. It is now not uncommon for sports medicine physicians to weigh in on the treatment of performing artists. The contributions of sports medicine to the diagnosis and treatment of performing artists’ injuries are becoming increasingly acknowledged and valued. Furthermore, a growing number of science-based research disciplines within the performing arts (i.e. dance science, performance science) are adding to the discussion too.

Admittedly, this has resulted in some concern being raised from pedagogues within the performing arts. I have had a number of such discussions (and at times debates) with pedagogues who doubt that sport and science have much to offer to the performing arts. “Sport is concerned with dynamic movement in a competitive, open environment”. “Applying scientific inquiries to the performing arts would strip away the artistry from what performing artists do and reduce it to quantitative numbers”.  Indeed, it would be easy to draw up a list of distinctions between sport, science, and the performing arts.

However, just as sports medicine can help artists receive appropriate treatment for their injuries and allow them to keep performing, the application of principles from sport and science can actually help reduce barriers and better equip artists with skills that allow them to focus more clearly on the artistic aspects of their craft. Indeed, there is considerable merit in the notion of treating (or considering) artists as athletes.  By no means is this to suggest that we reduce what artists do down to a string of analyzable numbers, but if we consider everything that goes into making their craft look effortless while on stage we could allow them to look effortless more easily.

So in addition to treating the injured performing artist and keeping them on stage, what can sport and science contribute to research and training for performing artists?

Educators do an excellent job of teaching young performing artists the craft of their area of performance. Young musicians, for instance, have no challenge learning the technique required to play their instrument and how to stylistically interpret standard repertoire. In addition to this now, educators, aided by researchers, are coming to consider and recognize the physicality and psychology of performance. It is recognized that learning to play an instrument and interpret standard repertoire is not all that is required to achieve and sustain a successful career as a performer. Once we develop a better understanding of the physical and psychological demands associated with learning and performing, we will be in a position to train our developing artists more effectively. This will ultimately createartists who are more successful,as well as artists who are healthier.

While we are developing a clearer understanding of how to treat performing artists’ injuries, we still don’t have a good understanding of how these injuries occur and what can be done to minimize their occurrence.Just as the physicality and psychology of performance are of growing interest to researchers and educators, so too are the physicality and psychology of injury occurrence and recovery.

Sport and science are currently informing a variety of lines of inquiry within the performing arts. For example, the role and relevance of fitness and strength for artists isnow being interrogated. We often hear now that “fitter dancers and musicians are better dancers and musicians”, but what aspects of fitness are most relevant? Should musicians aspire to be marathon runners, or should male dancers be concerned with how much they can bench press? Not necessarily. In dance, for instance, research has found that lower-body muscular power and aerobic fitness are associated with increased severity of injuries and increased length of time off due to injury, respectively. We also know that poor levels of aerobic capacity can induce fatigue which increases the chance of musculoskeletal injury; although the precise mechanism by which this happens is not yet fully understood. Researchers in sport have investigated similar questions and as such are well positioned to advise on methodological approaches for arts-based investigations.

While there is still much to learn within dance, very little is understood about the relevance of fitness for musicians. However, for anyone inclined to suggest that sitting at a piano all day moving their fingers can’t possibly be physically taxing, I would urge them to take a look at the attached video. The top number is a real-time display of the pianist’s heart rate as she performs the final section of Ligetti’s L’escalier du diable. This is of a graduate piano performance student who regularly practices between 10 and 12 hours a day. While all of her practice obviously isn’t at this intensity, it does demonstrate how demanding playing an instrument can be! Again, here is an example of how methodologies from sport can inform our understanding of the performing arts.

Ongoing research is producing a growing body of evidence-based knowledge about healthy and effective dance- and music-making. However, this knowledge won’t do much good if it isn’t passed along to educators and students. Doing so will allow us to shift some of our energies from treating artists’ injuries to preventing them.Again, sport has much to offer in terms of models for effectively disseminating this knowledge to performing artists, as well as recommendations for the training of artistsmore generally.

In order to assist athletes to attain their performance goals, and ensure healthy and sustained involvement, professional sporting bodies throughout the world are adapting long-term athlete development (LTAD) models. LTAD models emphasize the intellectual, emotional, and social development of the athlete, encourage long-term participation in physical activities, and enable participants to improve their overall health and well-being and increase their life-long participation in physical activity. This is achieved through the early and focused introduction of non-specific gross and fine motor skills, activity-specific technical skills, physical fitness, mental training and psychological skills, training and tactical/competition-specific skills, and interpersonal and social skills. Broadening the focus of young artists’ training to incorporate such aspects could help equip them with the skills to facilitate lengthy, health careers.

As mentioned above, as we come to understand the physicality and psychology of the performing arts, we will be better positioned to understand the necessary components of artists’ training. Considering the debilitating and injurious impact of fatigue, as well as burn out, introducing principles of periodization into dancers’ training has been recommended. Again, a made-in-sport training model.Sport also has much to offer in terms of how we might provide supplemental training to artists in fitness, strength, motor control, and psychological skills.

No doubt due in part to the money that can be associated with professional sport, those involved in sports medicine and research have made considerable progress in understanding how to treat and train their athletes. It is readily agreed that performing artists have little desire, and certainly no need, to have themselves or their artistry reduced to a string of quantifiable numbers. However, collaborations with sport stand to offer considerable benefits for aspiring and professional artists.

Equally, there is no reason that this conversation only proceed one way. It is highly plausible that these conversations could also foster mutually beneficial research activity applicable to high performance endeavours in both the performing arts and sport. For instance, the performing arts offer a unique venue within which to examine questions relating to the effects of intense, early engagement in an activity as well as the acquisition and development of fine motor control. No doubt such conversations and collaborations will prove fruitful for all involved!

Terry Clark

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Educating Today’s Musicians to Keep them Healthy and Active

Musicians are catching up to the athletes in recognizing the importance of educating themselves on the broad topics of health and wellness. Until more recently, musicians were likely to ignore or deny any medical problems they were experiencing, whether psychological or physiological, playing through pain until they could no longer continue. MTNA has taken a pioneering role in embracing the vital topic of musician wellness. Meeting the need for access to wellness information, MTNA has introduced a number of significant initiatives in this area. Over the past three decades, MTNA has utilized its educational conferences, publications and online wellness resources to disseminate this crucial information.

As injury rates increase in today’s highly frenetic and competitive world, studio music teachers have grasped the relevancy for educating themselves and their students on the various aspects of wellness. It is teachers who serve as their students’ first line of defense. In addition, it has become evident that a healthy, well-adjusted musician with an effortless technique will be more capable of achieving his or her maximal musical potential. As a result, the educational offerings in this field have continued to evolve, with professional music associations stepping up to meet the demand.

One of MTNA’s most valuable resources available to the public is its extensive online Wellness Bibliography. This is a searchable database of books, journals and websites annotated by Professor Linda Cockey, Salisbury University, assisted by Kathryn Kalmanson, Head of Research Services, Blackwell Library, Salisbury University. The American Music Teacher, MTNA’s professional journal, first published the Wellness Bibliography in its Dec/Jan edition 1997/1998 and continued to offer it annually in print and on the MTNA website. In 2008, the Bibliography ceased to be published in the AMT, residing solely on the MTNA website:

Ten Essential Skills for Promoting a Lifelong Love of Music and Music Making, a result of a 2003 MTNA Board directive, resulted in four in depth, wellness-related articles that are available on the MTNA website. Although inclusive of a more diverse range of important learning objectives, a number of the skills, and the ensuing articles, relate specifically to wellness issues. Those articles are:

  • Ten Essential Skills Part 2: “Developing the Fundamental Skill: Healthful, Injury-Preventive Technique” By Barbara Lister Sink.
  • Ten Essential Skills Part 3: “Risks and Rewards” By William Westney.
  • Ten Essential Skills Part 4: “Working for a More Musical Tomorrow” by Scott McBride Smith and Gail Berenson.

Psychological issues, particularly overwhelming performance anxiety, can be devastating to a musician of any age and is frequently the primary reason a student stops studying. It becomes the responsibility of the studio teacher to come up with appropriate strategies to help nurture their students’ self-confidence. A wide range of books targeting the subject of performance stress is available to provide guidelines for integrating topics such as relaxation, positive self-talk, desensitization, imagery, and common sense performance practices into lessons. Teachers do need to recognize when the students’ psychological needs exceed their training expertise and a referral to a medical professional is necessary. The same is true when a student shows signs of a physical injury.

Finally, a number of independent studio teachers are seeking ways to address the needs of the non-traditional student. MTNA offers a strand of sessions at its national conferences on the teaching of RMM (Recreational Music Making). This instruction typically attracts adult beginners age forty and above and is process-oriented instruction, in contrast to product-oriented instruction. The focus is on having fun and the joy of making music. Taught in a group setting, students are encouraged to not worry about perfection but to enjoy gaining a skill they’ve always wanted to pursue. Many in these classes are pursuing an item on their “bucket list”. It is very much like the recreational, weekend athlete who pursues a sport strictly for their personal enjoyment, accompanied by the same psychological and physical benefits that this kind of joyous activity creates.

Wellness-focused sessions are appearing more and more frequently at MTNA local and state affiliate conferences, as well as at the annual national conference. In addition, MTNA has periodically held wellness symposia co-sponsored by the Canadian Federation of Music Teachers’ Association. This collaboration is indicative of the partnerships that MTNA is pursuing worldwide to advocate for musician wellness. Clearly the demand is there, and teachers around the world are choosing to enhance their knowledge to maintain their own and the health of their students.

Gail Berenson, MTNA Past President

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The Case of the Accidental Collaboration

From awareness comes action when opportunity presents itself, at least that’s what happened to me.  I manage a music industry program at Loyola University New Orleans and I’m also a classically trained musician, a music producer, and half-ass jazz trumpet player so, naturally, I love musicians and music.

Maestro Jean Montes was in my office.  Speaking English in the French patois of a Haitian native, Jean was telling me about the needs of the youth symphony he conducts; he also the conducts the university symphony.

“We lose so many of these young people!  They practice too much, they practice incorrectly, they play too much and they injure themselves and then they cannot play anymore! It is a serious problem but no one seems to know of it except teachers and parents and they don’t know what to do about it or who to call.  It’s such a shame because music is the focus and passion for these young people.  It not allows them to make meaning, it gives them something to do, it makes them better students and, I think, better people.”

I was a bit surprised by this.  It was all quite dramatic but then he is a maestro and that’s why they get paid.  But I could tell from his sincerity that he was quite concerned about the problem, although I wasn’t sure why he was telling me about it.  We were having a conversation about how our music industry program could help his orchestra program.

Our students are good at producing stuff, making things happen, videotaping concerts and broadcasting them live on the Internet, and we can market and promote and take care of sync licenses and talent releases, but focal dystonia, carpel tunnel syndrome, muscular-skeletal injuries, repetitive stress, performance anxiety, hearing loss, tendonitis, loose teeth, cramps, nodules and polyps?

A week or so later I was dealing the usual array of phone calls and emails and there came this phone call I just happened to answer mostly because it was my phone and my assistant was out.

“Hello, may I speak to John Snyder?  My name is Randy Dick and I’m calling on behalf of the American College of Sports Medicine.”

I was tempted to say “One moment please, I’ll connect you” and hang up.  But, since I’m in academia, I said, “This is John Snyder, how may I help you”.

“The ACSM Joint Commission is meeting in New Orleans in February and we would like to arrange for a musician to talk to our group of 50 to 60 leaders in the field of sports medicine.”

“So, why are you calling me?”

“Well, I called the Chamber of Commerce and they recommended I call the Arts Council and the Arts Council recommended I call Loyola and Loyola recommended I call the College of Music, and that nice lady seemed a bit confused and recommended I call you.”

I get all the weird calls. I’m the default setting for weird calls. Not that I’m complaining, it’s usually a good thing so I was hoping for the best.  I asked Randy Dick to explain it to me again and as he was explaining it, it became suddenly obvious that this man’s request could connect musicians with sports medical professionals to the benefit of both.

It hit me that he could connect trainers, therapists and doctors who take care of high school and college sports teams with high school and college bands and orchestras, with Jean’s kids, with traveling musicians, with all musicians!  I reasoned that the sports world had to be much more developed in its methodologies for prevention and treatment of injuries than the arts world. I didn’t really think all of these things at once but I sure did over the next few days.

“Let me see what I can do”, I said, and we exchanged numbers and promises and I hung up.  I thought about the problem for a few minutes when in walks Adam Shipley who was managing Preservation Hall at the time and also teaching a course for our music industry program.  I blurted out my problem and he blurted out the answer:

“I can take care of that.  How many players?  What’s the money?”

I guessed “four” and “a Ben Franklin per?”

“Done.”  I knew I could squeeze $400 out of my operations budget so I thought it was a good deal all around.  I’d get my students involved.

Next thing you know it’s a few months later and we’re downtown at one of those boxy hotels in the Quarter and there was a sound system and my video kids were there and in walked the core of the Preservation Hall Jazz Band.  There were four of them, a drummer, a clarinet player, a keyboard player, and a trombone player.  They moved slowly but in concert, like basketball players walking onto the court, elegant and graceful, no energy wasted but quietly evincing the great power they can call up in a split second.  It was impressive.

I turned to my sound guy and said, “Can we handle this?”

The hardest part about videotaping stuff is getting sound to camera.  He said “We have four lavs and two hand helds but there’s a problem with the mixer so we can only get two mics to camera.”

“Fix it, please” (magic boss talk rarely works) and I went about setting up the band in that flat, semi-ballroom, facing 60 well-dressed sports medical professionals sitting behind long tables with microphones and glasses of water in front of each one of them.

The band was booked to play a few songs and then talk about the physical issues involved in playing a musical instrument for 40 or 50 years and being on the road for almost as many.  There was to be no moderator.

“Sorry boss, no can do.  This thing is busted.”

“Spare me the tech talk kid, what’s the alternative?”

Next thing you know I’m darting around with a hand held mic asking questions of the musicians like Jerry Springer on a short leash.  It wasn’t supposed to be me doing the talking or asking the questions.

Well, to make a long story longer, it was all a great success.  The band played wonderfully, questions were asked and answered, the sports medical people had their highest rated session ever, and the musicians were healed and received little plaques and great thanks.  It was one of those “happy feel good” experiences we tend to do well in New Orleans and the ACSM is good at too.

This was six years ago and a lot has happened since.  Many meetings and conference calls, presentations and conventions, website issues solved and documents exchanged, but there has always been a core group of people who’ve kept us going and led the way, who are determined to make the Athletes and the Arts initiative happen.  This includes Randy Dick and Kris Chesky and the leadership, staff, and membership of the ACSM and PAMA and the other partner organizations in the coalition, who together provide the paradigmatic example of the power of collaboration and common purpose.

How is that people come together to accomplish something greater than their individual goals?  The answer is their shared belief in the importance of a sustainable collaboration that benefits other people far into the future.

The future they see is one where musicians, dancers and all performing artists have access to the specialized medical attention the hazards of their occupations require; where fewer are injured and more are rehabilitated using the models of sports health management.

The future they see is one where young artists and athletes become aware of their responsibility to take care of their bodies – the platforms for the delivery of their art and athletic skills – by eating well, exercising regularly and adopting good health habits.

The future they see is one where high school and college sports trainers, physicians and therapists attend to the needs of school bands and orchestras, dance and theatre troupes, as well as to the school sports teams.

The future they see is one where the performing arts medical community is as supported, funded and research-dependent as the sports medical community; a future in which information and knowledge are shared and unknown connections are explored.

The future they see is one that improves the health and well being of performing artists and athletes of all ages, types, and levels of achievement.  From these two groups come the heroes of our youth, our culture and our society.  We emulate and celebrate our heroes and we certainly will eat, drink and do what they eat, drink and do.

What began as a musical presentation (“something different from concussions”) for a group of sports medical professionals has grown into a coalition of national organizations and dedicated individuals that has as its primary goal the good health and well being of others so that they may achieve their goals, reach their potential, and live their dreams as they create our arts and culture, our sports and entertainment, and a healthy and prosperous society.  I am very proud and humbled to be a part of such a group.

John Snyder

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GETTING TO THE HEART OF THE MATTER: Connecting the Dots to Improve the Well-Being of Musicians and Pro Football Players

“The music that can deepest reach, / And cure all ill, is cordial speech.”
-Ralph Waldo Emerson, writer and philosopher (1803-1882)

By: Bethany Ewald Bultman, President of the New Orleans Musicians’ Clinic and Assistance Foundation

New Orleans, known locally as the WHO DAT nation, is world-renowned for good music, good food, good times and our passion for our beloved Saints football. As the birthplace of the USA’s only indigenous art form – jazz – tourists from around the world visit our city for Mardi Gras, New Orleans Jazz & Heritage Festival, Halloween, Essence Festival, and a plethora of famed music clubs and community festivals. And, on February 3, 2013, the NFL Superbowl. At all of these events and countless conventions throughout the year, local musicians are the heartbeat of New Orleans: a vital contributor to the city’s economic viability and cultural identity.

Even before Hurricane Katrina’s floods devastated the city of New Orleans in August 2005, many musicians faced perpetual economic hardship and suffered poor health as a result of limited access to affordable healthcare and “death by lifestyle.” Nevertheless, their music sustained us and them. It got me thinking:Does playing music as a response to hardship increase a performer’s sense of well-being and help increase his or her lifespan?

At the New Orleans Musicians’ Clinic, 87 percent of our 2,400 musician patients receive medication for more than one chronic condition: hypertension, diabetes, cardiovascular disease, and asthma,to name a few. In part, these illnesses can be attributed to our zesty and wickedly unhealthy lifestyle paired with years of lack of access to high-quality, affordable medical care. Before our clinic was founded in 1998, New Orleans’ cultural icons continued to endure an epidemic of poverty and health care outcomes rivaling those of third-world nations. While the city’s tradition-bearers were celebrated the world over, at home, many lived hand-to-mouth, outside mainstream social and economic systems.

Our musicians come from communities that reflect both the pervasive poverty of New Orleans and the power of our culture to overcome adversity. As of the late 1990s, New Orleans was first in the nation in number of children living in poverty, second in low-birth-weight babies, and third in infant mortality. According to the Centers for Disease Control and Prevention (CDC), one-third of New Orleans residents were obese, making it the “fattest” city in the country. Since then, things have not changed much for the average African-American in the city.

According to “A Portrait of Louisiana,” the 2009 report from the American Human Development Project, life expectancy for African-Americans in New Orleans was 69.3 years, putting it on a par with North Korea, Colombia, Venezuela and Uzbekistan. The poor health indicators for the city as a whole are further compounded for musicians struggling to perform in an unhealthy work environment for hours, often working late nights for low pay in smoke-filled, noisy clubs. Other stressors include separation from their families while on the road, performance anxiety and other occupational health-related hazards.

Yet these athletes in the arts often play six to eight hours a day, seven days a week. They live to play and their music uplifts all who hear it. Clearly music is a calling which breathes life into its performers. And now let’s contrast this to the health outcomes of highly paid professional football players.

A records-based study of retired players conducted by the National Institute for Occupational Safety and Health (NIOSH) published in the American Journal of Cardiology in March 2012 noted that by the end of 2007, of the 3,439 former NFL players NFL, 334 were deceased. (Based on estimates from the general population, NIOSH anticipated 625 deaths.)

The results revealed that for those who played pro football at least five seasons between 1959 and 1988, nearly 38 percent of deaths from the pool of retirees were linked to heart disease. This came as a surprise to me, as I had assumed that football players had healthier hearts than average Americans since they’ve spent decades focusing on and building up cardiovascular strength in ways that the broader population likely doesn’t.

So I ask myself, what factors contribute to the longevity of some of the New Orleans musicians who don’t enjoy the same advantages as professional football players? As professional athletes, football players are cared for by top-notch doctors, physical therapists, nutritionists and even their agents. NFL retirees are more likely to have health insurance and memberships to health clubs than musicians of a similar age, particularly given retired NFL football players’ ability to pay for private insurance. It seems likely that increased availability to health care would mean that ex-players could receive more frequent cancer checkups, which would lead to early detection and more successful treatment.

The NIOSH study revealed troubling occupational data:

  • African-American players had a 69 percent higher risk of dying from heart disease than their white counterparts.
  • Players with a Body Mass Index of 30 or more during their playing careers had twice the risk of death from heart disease compared to other players, confirming traditional concerns about the effects of obesity.
  • Defensive lineman had a 42 percent higher risk of death from heart disease when compared to men in the general population.

In a subsequent article published on September 07, 2012, Robert Shmerling, M.D., Faculty Editor, Harvard Health Publications, examined the data from the NIOSH study and suggests that repeated head injuries at high speed could cause brain disease years later that resemble ALS or Alzheimer’s disease.

  • The risk of death from Alzheimer’s disease or ALS was nearly four times higher than expected.
  • Those who played a speed position (such as quarterback or receiver) had a risk of dying from Alzheimer’s disease or ALS that was more than three times higher than those playing “non-speed” positions (such as linemen).

What the NIOSH study does not document is the overall quality of life of former NFL players. I can attest that New Orleans musicians’ lives are sustained by the fact that they never retire from performing. Just last week, 101-year-old trumpet player Lionel Ferbos got a pacemaker to increase his stamina for performing with his band at his weekly gig at the Palm Court Jazz Café. I have a hunch that having sports medicine specialists and players host an open forum with New Orleans musicians during SuperBowl XLVII would yield valuable information to keep the hearts beating for performers of both disciplines.

Watch this TV interview with Lionel Ferbos on his 101st birthday.

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Practice and Performance in Perspective

In most sports, there are objective measures that can be used to show individual improvement.   These include variables measured by time (speed, quickness agility, pitch speed) or distance (jump height, long jump, javelin throw).   Just get a baseline, train, and re-evaluate.  You are either faster or slower. Even team sports have a metric – the final score.

Defining improvement in performing arts is more subjective (similar to such sports as gymnastics and diving).   There may be judges or just the perceptions of the audience.  The element of creativity is even more pronounced in the arts and even harder to define.   Yet performing artists spend countless hours practicing to get better; a “better” that may not be able to be objectively measured.

So what is the optimal number of hours to practice?   At what point do additional hours of practice hurt rather than help performance?

Let’s look to the athletics world for some guidance:

  • At the college level, NCAA athletes may participate in no more than 20 hours of practice a week, with one day per week completely off.   These rules are in place to allow student-athletes time to be students, but also for health and safety reasons.   At the same NCAA institutions, how many of the music or dance students are following this schedule?
  • Olympic athletes have a four-year training schedule that, at a very high level, consists of foundation work, overtraining, technique work and tapering to peak for two weeks during the Olympic Games.  Recovery is an important component of this cycle as well.
  • Coming off an arm injury in 2011, Washington Nationals pitcher Stephen Strasburg was shut down this season after reaching a pre-determined inning count to minimize his risk of long-term injury.  This strategy was based on data that showed when pitchers significantly increase the number of innings pitched from one season to the next, there was a much higher chance of an arm injury.
  • Many athletes cross-train to maintain aerobic fitness while minimizing the mental and physical stress associated with their principal sport.   Soccer players play basketball, swimmers do running workouts and vice versa.
  • When starting a program of walking for exercise, it is recommended to increase your steps by no more than 500 each week.

Many of these findings in the world of athletics can be transferred to the performing artist and you should consider applying these concepts to optimize your talent and longevity:

  1. The ability to identify and objectively measure improvement in each aspect of the performing arts is essential in order to better understand the volume and type of practice necessary to optimize performance.
  2. At some point the number of practice hours may hurt rather than help.
  3. Large ACUTE increases in the time spent physically practicing/performing may increase risk of injury.  If the volume or intensity of practice must increase, do it gradually.
  4. Consider FOCUSED practice segments with different goals in each session.   Rote repetition for extended periods of time has not proven successful in the athletic world.
  5. Cross-train:Take a mental or physical activity that allows the body to focus on something different.  RECOVER.
  6. Invest in your overall fitness to optimize your skill.   Use 30-45 minutes of your practice time for separate physical activity.

Finally, complement your practice with wise choices related to nutrition, hydration and other lifestyle issues, using this website and related resources as a foundation.  Investing in some of these lifestyle behaviors should both optimize your performance AND make it sustainable for many years to come.

We welcome your comments.

Randall Dick   Fellow, American College of Sports Medicine (ACSM)

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